| 上海市新生儿先天性心脏病筛查对报告发生率影响的中断时间序列分析 |
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| 引用本文： | 车贝贝, 郑旭彬, 许厚琴, 朱丽萍, 李冰莹, 徐飚. 上海市新生儿先天性心脏病筛查对报告发生率影响的中断时间序列分析[J]. 中华疾病控制杂志, 2023, 27(4): 413-418. doi: 10.16462/j.cnki.zhjbkz.2023.04.007 |
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| 作者姓名： | 车贝贝 郑旭彬 许厚琴 朱丽萍 李冰莹 徐飚 |
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| 作者单位： | 1.200032 上海，复旦大学公共卫生学院流行病学教研室;;2.200032 上海，复旦大学国家卫生健康委员会卫生技术评估重点实验室;;3.200433 上海，同济大学附属上海市肺科医院结核病临床研究中心;;4.200062 上海，上海市妇幼保健中心 |
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| 基金项目： | 上海市公共卫生体系建设三年行动计划(2020-2022)妇幼整链式全生命周期健康管理服务模式优化GWV-9.4上海市公共卫生三年行动计划流行病学重点学科建设项目GWV-10.1-XK16上海市妇女健康服务能力建设专项规划(2016-2020年)——上海市产前诊断管理平台建设项目Shanghai Health Planning for Women and Children [2018] No. 6 |
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| 摘 要： | 目的 评估上海市新生儿先天性心脏病(congenital heart disease, CHD)筛查项目实施前后CHD报告发生率和临床分型的变化。方法 基于上海市出生缺陷监测系统2014年1月―2017年12月的报告病例，以出生后42 d内诊断的CHD患儿为研究对象，按照CHD筛查项目实施日期，将研究分为筛查实施前(2014年1月―2016年5月)和筛查实施后(2016年6月―2017年12月)两个阶段。采用中断时间序列(interrupt time series, ITS)方法分析该筛查项目对不同类型CHD报告发生率的影响。结果 2014―2017年上海市共分娩849 981名活产儿，报告CHD患儿3 571例。筛查实施前，CHD的月均报告发生率为42.97/万(95% CI：41.19~44.82)，筛查实施后为40.60/万(95% CI：38.51~42.78)。ITS结果显示，前后两阶段CHD报告发生率分别随时间呈上升趋势(RR=1.013，95% CI：1.005~1.021)，但筛查的实施与CHD的报告率呈负相关(RR=0.706，95% CI：0.573~0.869)。按CHD临床分类分析，筛查的实施与卵圆孔未闭(RR=0.646，95% CI：0.461~0.904)和其他类型CHD(RR=0.458，95% CI：0.296~0.708)报告率呈负相关，而危重CHD占比与实施前相比上升明显(6.77% vs. 10.64%, P < 0.001)。结论 本研究发现CHD筛查项目实施后，基于医院监测的出生后42 d内婴儿CHD报告发生率下降，主要表现为部分可自愈或轻型CHD报告率下降，而需要重点关注和干预的危重CHD比例明显升高，提示筛查规范了CHD的诊断流程，筛查效率较实施前提高，促进了医疗卫生资源的合理利用。
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| 关 键 词： | 先天性心脏病 报告发生率 新生儿 筛查 中断时间序列 |
| 收稿时间： | 2022-08-08 |
| 修稿时间： | 2022-10-27 |
Impacts of implementing congenital heart disease screening program among infants on the disease report rate in Shanghai: an interrupted time series analysis |
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| CHE Beibei, ZHENG Xubin, XU Houqin, ZHU Liping, LI Bingying, XU Biao. Impacts of implementing congenital heart disease screening program among infants on the disease report rate in Shanghai: an interrupted time series analysis[J]. CHINESE JOURNAL OF DISEASE CONTROL & PREVENTION, 2023, 27(4): 413-418. doi: 10.16462/j.cnki.zhjbkz.2023.04.007 |
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| Authors: | CHE Beibei ZHENG Xubin XU Houqin ZHU Liping LI Bingying XU Biao |
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| Affiliation: | 1. Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China;;2. Key Lab of Health Technology Assessment, National Health Commission, Fudan University, Shanghai 200032, China;;3. Clinic and Research Center of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China;;4. Shanghai Center for Women and Children's health, Shanghai 200062, China |
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| Abstract: | Objective To evaluate the changes in overall and subtype-specific report rate of congenital heart disease (CHD) among infants before and after implementing a municipal screening program in Shanghai. Methods Based on the Shanghai Birth Defects Surveillance System, all CHD infants diagnosed within 42 days after birth were included in this study from January 2014 to December 2017. Pre- (January 2014 to May 2016) and post-program (June 2016 to December 2017) phases were defined according to the date of implementing the CHD screening program. The interrupted time series (ITS) analysis was used to evaluate the impact of the screening program on overall and subtype-specific CHD report rates. Results In total, there were 849 981 live births in Shanghai between 2014 and 2017, of whom 3 571 were confirmed with CHD. In the pre-program phase, the average monthly report rate of CHD was 42.97 (95% CI: 41.19-44.82) per 10 000 live births, while decreasing to 40.60 per 10 000 live births (95% CI: 38.51-42.78) in post-program-phase. ITS analysis found that both the pre and post-phase presented an increasing trend of CHD report rate (RR=1.013, 95% CI: 1.005-1.021); While the overall reported rate of CHD was negatively associated with the screening implementation (RR=0.706, 95% CI: 0.573-0.869). Regarding specific clinical subtypes, the report rates of patent foramen ovale (RR=0.646, 95% CI: 0.461-0.904) and other CHD subtypes (RR=0.458, 95% CI: 0.296-0.708) were significantly decreased along with the CHD screening. However, the proportion of infants with critical CHD increased significantly among total reported cases after implementing the screening program (pre-program phase vs. post-program phase: 6.77% vs. 10.64%, P < 0.001). Conclusions After the CHD screening program's implementation, the observed decrease in hospital-based CHD report rate among infants within 42 days of birth was mainly attributed to the deceased report of mild and self-curable CHD. By contrast, the proportion of infants with critical CHD, i.e., those who should be critically concerned and timely intervened, was increasing. Findings from this study suggest that the CHD screening program in infants has established a standardized diagnostic procedure and brought about better screening efficiency and optimal use of health resources in Shanghai. |
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| Keywords: | Ongenital heart disease Report rate Neonatal Screening Interrupted time series |
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